The Trouble With Dentistry
In May, Ferris Jabr wrote about a dentist named John Roger Lund, who allegedly defrauded many of his patients by giving them unnecessary treatments. Lund was an outlier, but even the most common dental procedures, Jabr wrote, are not always as safe, effective, or durable as we are meant to believe.
Thank you for publishing “The Trouble With Dentistry.” Overtreatment is a serious problem in our profession. While some patients wish to have perfect, bright-white smiles and a mouth that looks like it has never had any problems, most people want to be able to eat without pain and to have reasonably good aesthetics. It’s pretty easy to provide this without major, expensive dentistry—but the dentist won’t make much money. And that’s a problem. By the time a dentist gets out of school and sets up or buys an existing practice, he or she can easily be close to $1 million in debt. In the United States, poor populations are largely underserved in medicine as well as in dentistry. If our society were to offer some form of tuition reduction for serving those populations, both conditions could be helped.
David Dalley, D.D.S.
The American Dental Association and dentists across the country are dedicated to the health and safety of the patients they serve. As a dentist for 32 years, I was disappointed by the author’s reinforcement of inaccurate, negative stereotypes about dentists, and the use of one example of alleged professional misconduct to make blanket statements about the entire dental profession.
The ADA is dedicated to evidence-based dentistry, which integrates the dentist’s clinical expertise, the patient’s needs and preferences, and the most current, clinically relevant evidence. All three are part of the decision-making process for patient care. To that end, the ADA successfully advocated for evidence-based dentistry to become a required component of dental-school curricula and established the Center for Evidence-Based Dentistry to develop resources that help dentists integrate relevant scientific evidence into patient care. We have the data to show that dentists all across the country are accessing this content.
The author’s implication that dentists are motivated by profit to pay down high educational debt is not borne out by the facts. For instance, dentists have for decades advocated for fluoridation of community water supplies to prevent tooth decay. Why does the profession advocate for something that results in less need for treatment? Because dentists are doctors of oral health, and tooth decay is a disease that we want to prevent for the good of the public.
Jeffrey M. Cole, D.D.S., M.B.A.
President, American Dental Association
At the Harvard School of Dental Medicine and other dental schools nationwide, ethics and professionalism are at the heart of dental education. We teach evidence-based dentistry and highly value scientific inquiry, requiring every student to conduct research. We put patients’ welfare above all else.
Speaking as the dean of a dental school, a role I’ve held for more than 25 years, I can assure you that the overwhelming reason students go into the field is because of their desire to help others. Dentists are caring, ethical, and knowledgeable professionals who serve their communities and care deeply for their patients. Dentists deserve better than the unflattering portrayal in this article.
Bruce Donoff, D.M.D., M.D.
Dean, Harvard School of Dental Medicine
I was in dental school in the late 1980s. A joke freshman year revolved around our professors’ not even being able to go to the latrine without at least three coordinating peer-reviewed double-blind studies to say it was a good idea. Granted, we dentists don’t have the breadth of research that our medical colleagues do, but we represent only 4.5 percent of the nation’s health-care bill.
Kenneth E. Chapman, D.D.S., M.A.G.D.
Ferris Jabr’s reliance on the Cochrane organization’s concerns about the scientific validity of some clinical studies and common recommendations is flawed. The Cochrane organization’s mission is to point out where evidence-based science is lacking. A lack of evidence does not make something untrue. There is a lack of solid evidence based on scientific research for the benefits of flossing, because it is virtually impossible to follow a large group of people for years to verify their self-reported daily flossing habits and techniques, to rule out myriad other factors affecting the study, and to put a control group at serious health risk by forcing them not to floss for years. As to the scientific validity of dental treatments such as crowns and root canals, plenty of evidence supports their need. But how can we ask a large group of people in several different studies to not restore a root canal with a crown, just to see what happens? Some medical and dental recommendations still rely on clinical experience and cannot be scientifically validated through evidence-based studies. This does not make those recommendations bad or untrue.
Joseph A. Oleske
I am a retired dental hygienist and would like to point out another troubling trend in dentistry: Many of the big dental chains pay their dentists and hygienists on commission. Often while filling in for colleagues, I would find that their periodontal-probe measurements were high (resulting in the recommendation of costly scaling and root-planing procedures), when my readings were that of a healthy mouth. Attendance at monthly staff meetings was required, and commissions were posted and discussed as a means of creating competition among dentists and hygienists. With that as common practice, how could dentistry be anything but corrupt?
Kudos to Ferris Jabr for his insightful article. Some years ago, as a newcomer to our area who rarely had dental problems, I visited prospective dentists on the recommendation of my previous (and trusted) dentist as well as co-workers. One of these was a well-known and well-advertised practitioner. I had what I thought was a routine examination and cleaning. To my surprise, I was then presented with a written, multipoint “treatment plan” laying out a number of significant procedures that needed to be done as soon as possible. The cost would be more than $5,000. I was told that this plan was a requirement of the Florida Board of Dentistry, or some such body. When I demurred at committing to such a plan on first acquaintance, I was asked to sign the plan to indicate that I had refused this “necessary” treatment and told that the dentist would need this for his records.
Fast-forward 15 years. I have had none of his required procedures (or any other significant dental work). I have been with my current practitioner for nearly all of this period. I’m told my teeth are just fine.
I am in my 50s and had a colonoscopy, as my physician recommended. I’m glad he didn’t describe it as “shoving a camera and hose up my butt to look at my bowels, and using an electric hot wire to rip and burn out any polyps that might be found.”
You can describe absolutely any dental or surgical procedure with emotionally charged and barbaric terms—cutting, hacking, ripping. But the majority of my colleagues went into health care and go to work every day to help people with their problems in the best way we can. We certainly do not hack and rip. We treat people and their teeth, soft tissue, bones, and organs as delicately as the task allows. Everything I do for my patients is what I would do for my most treasured family member or friend.
Andrew C. Hartwig, D.D.S.
Iowa City, Iowa
Ferris Jabr replies:
In the past few months I have received numerous emails from dentists. Many were angry or resentful, but the majority applauded the article and affirmed its central points. As the article states several times, most dentists behave ethically. Many of the article’s critics conveniently ignore the actions of Dr. Brendon Zeidler, who is a paragon of conscientiousness and integrity. The narrative concerning Dr. John Roger Lund is not presented as a portrayal of all dentists, but rather as a case study illustrating a troubling trend. One of the challenges in reporting this piece is that definitive statistics about overtreatment are lacking because it is a largely overlooked problem. Yet the available evidence—from the few studies that have been conducted, newspaper archives, court records, and interviews with dental practitioners and patients—indicates that Lund is far from alone.
My article explores the many historical, financial, and cultural explanations for intentional and inadvertent overtreatment in dentistry, including the profession’s deficit in rigorous clinical evidence. Joseph A. Oleske is mistaken about the Cochrane organization; its purpose is not to highlight missing evidence but rather, according to its website, to “study all of the best available evidence generated through research and make it easier to inform decisions about health.” Oleske further claims, “The lack of evidence does not make something untrue.” That is an ontological problem. The relevant question is whether there is enough evidence to establish a treatment’s benefits and justify its risks. As I acknowledged in the article, many dentists are advocating for evidence-based practices and necessary reform. Unfortunately, Jeffrey M. Cole’s claim that “dentists all across the country” are embracing evidence-based dentistry is contradicted by practitioners who have repeatedly lamented its slow adoption. As one of my sources pointed out, simply making information available or adding it to a curriculum does not translate to a swift or thorough transformation of an entire profession.
I am encouraged by the many dentists who concede their field’s flaws and are striving to remedy them. I hope the dental community will listen to the thousands of patients who recognized themselves in this story.
Behind the Art
“The Trouble With Dentistry” is a story about abuse of power. Ferris Jabr writes about Dr. John Roger Lund, who allegedly defrauded many of his patients to secure higher profits for himself. This apparent exploitation suggested a wide range of possible imagery: a tooth as a piggy bank; an oil rig inside a mouth; a mountain of removed teeth. I intended for the art to convey a sense of nefarious drama without being too gruesome. I also wanted to capture some of the scarier aspects of even the most routine dental checkup (we’ve all been in that chair, unable to speak as sharp implements descend toward our mouth).
After some discussion with the editors, I narrowed down the concepts. The art that opens the story is a giant tooth wrapped in caution tape; it’s meant to evoke a crime scene. Still, I didn’t want to indict the entire practice of dentistry, and it was important to me that some of the art be relatable to all dental patients. Beneath Lund’s story lies a simple truth: Our teeth are sensitive, and so are we.
Associate art director, The Atlantic
The Penance of Doc O
In May, Sam Quinones wrote about Lou Ortenzio, a trusted West Virginia doctor who got his patients—and himself—hooked on opioids. After Ortenzio lost his medical license, he took a night job delivering pizza, which sometimes brought him face to face with former patients. Now he’s trying to rescue his community from an epidemic he helped start.
For years, I blamed Lou for my mother’s addiction. I remember how we would pharmacy-hop to fill all the prescriptions he wrote her. I also remember my dad calling his office and screaming at the receptionists to tell him to stop prescribing her all these unnecessary drugs. I remember the day I found my mom overdosed on our back porch. I was 6. I felt Lou was the reason I had been robbed of having a normal mother. In the end, no one held a gun to her head and said, “Take these pills.” In the end, he was an addict himself. He needed help just like my mom.
When I started working in home health in 2014, I had a patient at the Mission, a shelter that houses dozens of opiate addicts. I walked in and was greeted by a guy smiling ear to ear. He said, “Hi there! I’m Lou Ortenzio. Have you ever been here?” My mouth dropped. I finally put a face to the guy I had blamed for all those years, but surprisingly, I wasn’t resentful anymore. I saw firsthand what he was doing for our community. It changed my entire perception of this person, of whom I had thought the worst. I applaud Lou for changing himself for the better, for lifting up our community, and for being a part of the change.
#Tweet of the Month
This man, Dr. O, was my childhood physician. I'll never forget the time I opened the door and he handed me my own pizza. But I didn't feel sorry for him, I admired his bravery—even then—to share his story so that others can learn from his experience.— @AByrdinthehand
April 23, 2019
Why Young Adults Are Talking Like 3-Year-Olds
Embracing your inner child is comforting and fun, John McWhorter argued in May—and it just might revitalize the English language.
Every parent who has ever tucked in their children has marveled at the “cuteness” of their linguistic development. My son once asked, “Daddy, remember the day when this day was coming?” before securing the word yesterday. The “cuteness” of children’s language is a window not only into brain development but also into the sorting-out of concepts such as time in its full continuum, day and night, and life and death, and eventually the building blocks of abstract thought. It is cute and delightful to us, but it is serious work for our children.
Today’s baby-speak in adults seems more a retreat from adulthood, a turning-of-backs on reality because the future scares the hell out of all of us. Children make up words and play linguistic games to race toward the future and maturity. Adults use the same “cute” exercises to back away from the future.
Karl E. Felsen
I don’t think the slang terms and manners of speech that the author of this article mentioned should be celebrated. For instance, the statement “I get paid a crummy wage because capitalism” is not only grammatically incorrect—it also suggests that one should believe that capitalism is the source of the person’s crummy wage, without looking more deeply into the issue. What then happens is loss of inquiry as well as a lack of understanding of the very language we speak.
It was validating to read this article after months of hearing my 11-year-old talk about “yeeting” things into her backpack and exclaiming “Yeet!” whenever she got excited about anything (accompanied by the celebratory gesture, of course). She assured me this was “a thing,” but until I read this article, I didn’t fully believe her.
For years I have thought of “kidspeak” as immature or ignorant. I am 26, and admittedly I was unaware of the word yeet. Now you have humbled me. It does take a degree of creative thinking and intellect to create and use “kidspeak” in a proper way.
Watch Your Wallet
Pickpockets love our digitally distracted age, Rene Chun wrote in May.
Your article was very informative and helpful. After reading it, I thought I would try my skill. Following a quick loving embrace, I slipped my husband’s wallet into my pocket. Not until about three hours later, when we were at a store and he reached for some money, did he notice it was missing. The fun was his surprise when I handed it to him.
Was Shakespeare a Woman?
The authorship controversy has yet to surface a compelling alternative to the man buried in Stratford. Perhaps that’s because, until recently, no one was looking in the right place. In June, Elizabeth Winkler made the case for Emilia Bassano.
I thank you sincerely for shedding a light on the literary work published by William Shakespeare. I feel chills as I reread the texts and think of a woman holding the pen, creating, imagining, challenging, and improving the English language. How fantastic would it be if we could demonstrate that the crepitating pulse that has made us dream for centuries actually came out of the creative genius of a woman?
On the purported Shakespeare authorship question, there is no scholarly debate. There is a fascinating area of inquiry concerning Shakespeare’s collaborations with other dramatists both early and late in his career, but this is far removed from the fantasy that some romantic figure used a jobbing actor from Stratford as a frontman for works of literary genius. There are a mere handful of academics who give this stuff even the time of day, let alone credence, and Winkler has misrepresented the state of scholarship by insinuating that they are one side in a scholarly dispute.
Excerpt from a Quillette.com post
“Was Shakespeare a Woman?” was a delightful reminder of the richness of the authorship field and the tantalizing possibilities it surfaces for answers to one of history’s great mysteries. Some are ready to heap vitriol on those who dare to entertain those possibilities. Specific points can always be debated, and unwarranted claims should be called out as such. But much compelling evidence and thoughtful analysis await those who approach the subject with an open mind and humble curiosity. Whoever he or she was, “Shakespeare” would enjoy the debate.
Elizabeth Winkler replies:
“Any worthwhile history is a constant state of self-questioning,” the author Hilary Mantel observed in her Reith Lectures for the BBC. It was in that spirit of skepticism that I undertook a provocative inquiry, exploring the possibility of a woman’s hand in the works of Shakespeare. Following the traditions of The Atlantic, I questioned uncritically held assumptions instead of treating pronouncements by authorities as truth. Consistent with journalistic duty, I distinguished academic opinion and received wisdom from fact as I explored terrain on which evidence has proved open to varying interpretation. In their often vitriolic zeal to condemn me for nonadherence to their position, some critics have misconstrued my careful formulations and denounced my endeavor as “conspiracism.” More troubling still, they’ve missed my very point of departure—that a woman writing under another’s name isn’t conspiracism; it’s a literary practice that we know has gone on for much of history.
The discourse around the question of Shakespeare authorship is plagued by this sort of anti-intellectual suppression of inquiry. The idea of a female author is speculative, to be sure, butt he animating impulse of my essay was neither doctrinaire denial nor adamant certainty. It was self-questioning, fueled by a recognition of how women’s voices have been hidden. Careful readers will note that I never claim Emilia Bassano was the author; indeed, I characterize the evidence as “circumstantial” and note that Bassano’s style differs from Shakespeare’s. I wonder, too, about the possibility of collaboration. (If Shakespeare had co-authors, as scholars now concede, can we be sure a woman wasn’t among them?) Implied in all of this is the question of what other women might merit consideration in connection with English literature’s greatest—and startlingly feminist—plays.
The personal attacks and rhetorical dismissal that greet such questioning may be intended to stigmatize the questions, yet instead they reinforce their legitimacy. As the author of the plays recognized, history is a fragile construct, “a scribbled form, drawn with a pen / Upon a parchment.” Scholarly opinion isn’t fact; assertions by authorities aren’t truth; and the journalistic imperative to question orthodox thinking requires doubt. People are loyal to the first version of history they learn. Mantel notes: “If you challenge it, it’s as if you’re taking away their childhood.” In this climate, accusations of denialism betray themselves as projections, and the impulse to skepticism emerges not as madness, but as the only rational and responsible approach.
Get Off My Lawn
In April, James Fallows wrote about how a small group of activists—himself included—got gas-powered leaf blowers banned in Washington, D.C.
I am in total agreement with James Fallows. I work for a parks nonprofit in Chicago and we made the switch from gas-powered leaf blowers a few years ago in response to park patrons’ complaints of fumes and noise, and their concerns about sustainability. We have a few batteries we swap out among leaf blowers and weed whackers. The batteries charge relatively quickly. Noise and pollution levels are down. We don’t have to spend staff time on going to the gas station or maintaining the combustion engines (a real nuisance). The batteries and tools paid for themselves in one season with only about one hour of use each week. It’s a wonder more individuals and land managers haven’t already made the switch!
Assistant Director of Park Management and Sustainability, Lincoln Park Conservancy
I am the only one on my street whose leaf blower collects dust in the cellar; my broom and rake are readily available. It’s not a time-saver, but my heart, my shoulders, and my soul enjoy the workout. Plus, I can hear the birds make fun of me for working on my day off.
I was delighted to discover so much space dedicated to that erroneously named machine, the “leaf blower.” (A short drive through my neighborhood any day of the week proves that it’s actually a dust blower.)
In the article, however, the emphasis was on the noise rather than the dust. Yes, you probably will lose your hearing eventually, if exposed to the noise. But the spores; pesticides; rat, coyote, raccoon, and dog feces; and hundreds of other elements in the dust will, in time, affect your lungs. And what about the gardener? He is particularly at risk. He blows dust from eight or 10 houses a day every day of the week. Don’t we care about his health?
Many people who buy organic food, recycle, drive a Prius, donate to ocean-conservation efforts, and tell you that their children’s health and safety is their No. 1 priority still allow their gardeners to use a blower.
I say ban all leaf blowers. How beautiful is the sound of a rake.
Santa Monica, Calif.
James Fallows replies:
I’m glad to learn from Aaron Hammond that the Lincoln Park Conservancy has been ahead of the trend in switching away from hyper-polluting, uniquely noisy gas-powered leaf blowers. As public-health evidence about the dangers of emissions—and of noise—from gas-powered leaf blowers rapidly mounts, and as battery-powered alternatives become cheaper and more effective, the pace of change is speeding up. Ongoing updates about communities making this change can be found at QuietCleanDC.com.
Personally, I agree with Colleen Maillie. But because I know most householders who hire lawn crews won’t agree, I’ve been pushing for the battery-powered alternatives.
I also agree with Sandra Snegoff, about the many forms of destruction wrought by modern, industrialized perfect-lawn care. My story stressed that the people most exposed to these risks are the lawn workers—many of whom are immigrants and non-English speakers, and very few of whom have good long-term health-care coverage. The shift of rules in D.C. is one modest step in the right direction. Our group’s watchword is that we have been “accelerating the inevitable.” We hope that communities across the country prove us correct.
The Big Question
On Twitter, we asked people to pick their favorite reader responses to June’s Big Question. Here’s how they voted.
45% The Segway
36% Engagement rings
17% The car alarm
2% The clock
“Was Shakespeare a Woman?” (June) stated that scholars suggest the Bassano family were conversos. We have updated the article online to reflect that several archival documents have led some scholars to dismiss the possibility that the Bassanos were ever Jewish.
We want to hear what you think about this article. Submit a letter to the editor or write to firstname.lastname@example.org.